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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ9972218
Regular
May 30, 2025

Andres Hernandez vs. Pearce Services, Inc.; Sparta Insurance Company

This case concerns Andres Hernandez's Petition for Reconsideration regarding a workers' compensation administrative law judge's finding that his Petition to Reopen was time-barred by Labor Code section 5410. The applicant sustained an industrial injury to his left knee in December 2013, leading to a stipulated Award in May 2015. Following left knee surgery in October 2018, he filed a Petition to Reopen in February 2019, claiming new and further disability. The Workers' Compensation Appeals Board affirmed the WCJ's decision, concluding that the five-year statute of limitations was not tolled by the defendant's provision of benefits or notices, as the applicant did not prove receipt or reliance on any affirmative statement to delay filing before the limitation period expired. Thus, the claim for new and further permanent disability was barred.

Petition to ReopenFive-Year Statute of LimitationsLabor Code Section 5410New and Further DisabilityStipulated AwardTemporary DisabilityPermanent DisabilityNotice of Ending BenefitsTollingEstoppel
References
Case No. ADJ3574604
Regular
Mar 29, 2013

WILLIAM BURDINE vs. CEMEX, INC., GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The petition was denied because it failed to make specific references to the evidentiary record and lacked required attorney information in the filing's heading. The Board adopted and incorporated the WCJ's report and recommendation, which also recommended denial based on the insufficiency of the defendant's petition and an analysis of the medical evidence and vocational expert testimony. Ultimately, the applicant was found to be 100% permanently totally disabled.

Workers Compensation Appeals BoardCemex Inc.Gallagher Bassett Services Inc.Petition for ReconsiderationWorkers' Compensation Administrative Law JudgePermanent Total DisabilityApportionmentAgreed Medical ExaminersCumulative TraumaNeck Injury
References
Case No. ADJ3855232 (LAO 0400735)
Regular
Apr 01, 2015

Roberto Barrero vs. Knudsen Dairy Corporation, Fireman's Fund Insurance Company

This case involves a dispute over the compensability of cardiovascular injury and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) following a 1975 industrial injury. The Workers' Compensation Appeals Board (WCAB) affirmed the findings that the applicant failed to prove CIDP was work-related but sustained his burden that cardiovascular treatment is a compensable consequence of the industrial injury. The WCAB clarified that enforcing medical treatment for the cardiovascular condition, which arose during authorized back surgery, falls under its continuing jurisdiction, not a prohibited amendment of the original award more than five years post-injury. Medical opinions regarding causation were found to constitute substantial evidence, resolving conflicting expert testimony.

Workers' Compensation Appeals BoardRoberto BarreroKnudsen Dairy CorporationFireman's Fund Insurance CompanyADJ3855232Van Nuys District OfficeOpinion and Decision After ReconsiderationFindings of FactWCJindustrial injury
References
Case No. ADJ11077399
Regular
Jul 08, 2019

JOLINA NEIDLINGER vs. STERLING JEWELERS, INC., XL SPECIALTY INSURANCE

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior award, and remanded the case for further proceedings. The Board found that neither the defendant's expert opinion nor the applicant's primary treating physicians' reports constituted substantial medical evidence to support the initial finding of industrial injury. The applicant's medical reports were insufficient to establish causation to a reasonable medical probability, necessitating further development of the medical record.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardOpinion on DecisionInjury AOE/COESubstantial Medical EvidencePrimary Treating PhysicianPanel Qualified Medical EvaluatorSubarachnoid HemorrhageTraumatic Brain Injury
References
Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ9635767
Regular
Jun 27, 2016

TOBY WILSON vs. KAISER PERMANENTE MEDICAL GROUP, ATHENS ADMINISTRATORS

The Workers' Compensation Appeals Board denied Toby Wilson's Petition for Reconsideration. The Board found applicant's attorney engaged in misconduct by raising new issues, misrepresenting facts, and relying on inadmissible evidence. Medical evidence failed to establish a work-related causation for the claimed left shoulder and hand injury due to inconsistencies and lack of medical certainty. The applicant did not meet her burden of proof, and the Board adopted the WCJ's report in its entirety.

Petition for ReconsiderationWCABKaiser PermanenteAthens AdministratorsToby WilsonFletcher Bernard BrownWCJ reportAppeals Board Rule 10842(a)sanctionsADJ9635767
References
Case No. ADJ548925 (MON 0313676) ADJ2470845 (MON 0313677)
Regular
Jul 19, 2010

Barry Robey vs. HERTZ CORPORATION, NATIONAL UNION FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, reversing a lower decision that awarded unapportioned permanent disability. The Board found that the Agreed Medical Examiner's (AME) apportionment of 50% of the applicant's left hip disability to a non-industrial arthritic condition was substantial medical evidence, despite the WCJ's finding that the AME's reasoning was "arbitrary." The Board emphasized that AME opinions on apportionment need only be based on reasonable medical probability, not certainty, and that the AME sufficiently explained his reasoning.

Workers Compensation Appeals BoardReconsiderationFindings and AwardCumulative TraumaIndustrial InjuryApportionmentAgreed Medical ExaminerPermanent DisabilityNon-industrial CausationLabor Code Section 4663
References
Case No. ADJ4416816 (AHM 0140718); ADJ3554653 (AHM 014719)
Regular
Sep 22, 2010

MARK ROGERS vs. ALL ABOUT FLOORS, INC., PREFERRED EMPLOYERS INSURANCE COMPANY and STATE COMPENSATION INSURANCE FUND; BARRETT BUSINESS SERVICES A.K.A WESTERN FLOORING INSTALLATIONS, PSI

This case involves Mark Rogers' claim for workers' compensation benefits for back injuries sustained while employed by All About Floors, Inc. and Barrett Business Services. The applicant alleged cumulative trauma injury, but medical evidence from Dr. Einbund was inconsistent. Despite Dr. Einbund's initial uncertainty and later inability to state with reasonable medical certainty that a cumulative trauma injury occurred, the Workers' Compensation Appeals Board (WCAB) denied reconsideration. The WCAB adopted the WCJ's report, which found the applicant's testimony credible and supported by medical reports, thus deeming the medical opinion substantial evidence to uphold the findings of fact.

WCABReconsideration DeniedPetition for ReconsiderationCumulative Trauma InjuryMedical EvidenceCausation of InjuryDeposition TestimonyApplicant TestimonyJob DutiesSubstantial Medical Evidence
References
Case No. ADJ10986659
Regular
Sep 30, 2025

ALFREDO SERRANO vs. BIG IDEA HOLDINGS, LLC; OLD REPUBLIC INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to further study the legal and factual issues raised by the Petition for Reconsideration. Applicant sought reconsideration of the January 27, 2022 Findings and Award, challenging the findings regarding a specific industrial injury to his right shoulder and a claimed cumulative injury. The Board concluded that the medical-legal opinions of the Qualified Medical Evaluator (QME), Dr. Bruce Huffer, were legally insufficient and analytically incomplete because he applied an incorrect legal standard for causation and apportionment, repeatedly requiring 'certainty' instead of 'reasonable medical probability'. Consequently, the Board rescinded the F&A and returned the matter to the trial level for further development of the medical-legal record, suggesting the selection of an Agreed Medical Evaluator.

QMEcumulative injuryapportionmentarthroplastysubstantial evidencemedical-legal opinionsrecord developmentLabor Code section 5701reasonable medical probabilitysuperimposed injury
References
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